A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Red. Following a partial gastrectomy for adenocarcinoma of the stomach, the gastric secretions are expected to be red due to the presence of blood. This is a crucial indicator of potential postoperative complications such as bleeding, which requires immediate attention to prevent further complications. Option A) Brown is incorrect as brown gastric secretions are more indicative of older blood or bile present. Option B) Clear is incorrect as clear gastric secretions are not typically expected postoperatively in this context. Option D) Yellow is incorrect as yellow gastric secretions may indicate the presence of bile. In an educational context, understanding the color and consistency of gastric secretions postoperatively is vital for nurses to assess and monitor patients for any potential complications. Recognizing abnormal findings promptly can lead to timely interventions and improved patient outcomes. This knowledge also helps nurses provide comprehensive care and communicate effectively with the healthcare team regarding the patient's condition.

Correct Answer: A

Rationale: In this question, the correct answer is A) 60 ml. To understand why this is the right choice, we need to consider the given concentration of the supplement, which is 80 ml of supplement mixed with 20 ml of water. The total mixture is 100 ml. When we are asked how much water to mix with an 8 oz (240 ml) can of feeding, we need to maintain the same concentration ratio. To calculate the amount of water needed, we use the ratio of supplement to water, which is 80 ml to 20 ml. If we consider 240 ml of feeding as the total (100%), we can set up a proportion where x (amount of water needed) is to 240 ml as 20 ml is to 100 ml. Solving this proportion, we find that x = (20 * 240) / 100 = 48 ml. However, since we already have 20 ml of water in the 8 oz can, we only need to add 60 ml more to reach the 80 ml total required for the correct concentration. Now, let's evaluate why the other options are incorrect: B) 70 ml: This amount does not maintain the correct concentration ratio of 80 ml supplement to 20 ml water. C) 80 ml: This option suggests adding the same amount of water as the supplement, which would disrupt the correct concentration ratio needed for the enteral feeding. D) 90 ml: Adding 90 ml of water would dilute the supplement beyond the required concentration, making it incorrect for the enteral feeding. Educationally, understanding how to calculate and maintain proper concentrations for enteral feedings is crucial in medical-surgical nursing. It ensures that patients receive the appropriate nutrients and medications in the right proportions to support their health and recovery. Mastering these calculations is essential for providing safe and effective care to patients requiring enteral nutrition.

Correct Answer: A

Rationale: In this case, the correct answer is A) Ileostomy. An ileostomy typically produces malodorous, enzyme-rich, caustic liquid output that can be yellow, green, or brown in color. This is due to the fact that an ileostomy is created from the small intestine, where digestive enzymes are still present, leading to the characteristic output described. The incorrect options include B) Ascending colostomy, C) Transverse colostomy, and D) Descending colostomy. These types of colostomies are created from the large intestine (colon) where the stool is more formed and less liquid compared to the small intestine. Therefore, they would not produce the same type of malodorous, enzyme-rich, liquid output as an ileostomy. In the context of medical surgical nursing, understanding the different types of stomas and their expected outputs is crucial for providing optimal care to patients with ostomies. Recognizing the characteristics of each type of stoma helps nurses in assessing and managing complications, providing appropriate patient education, and promoting patient comfort and quality of life.

Correct Answer: B

Rationale: The correct answer is B: "The drainage will decrease daily until the bile duct heals." Rationale: This information is crucial for George to understand as it prepares him for what to expect post-surgery. After gallbladder surgery with a T tube in place, the drainage from the tube will gradually decrease as the bile duct heals. This education empowers the patient to monitor his recovery progress and alleviates unnecessary anxiety about the drainage. Option A: "If there is any drainage, notify the surgeon immediately." While it is important to monitor drainage, not all drainage warrants immediate notification. This option could cause unnecessary alarm for the patient. Option C: "First, the drainage is dark green; then it becomes dark yellow." This information, although descriptive, does not provide actionable guidance for the patient in managing the T tube drainage. Option D: "If the drainage stops, milk the tube toward the puncture wound." This instruction is incorrect as milking the tube can lead to complications such as dislodging the tube or causing injury to the bile duct. In an educational context, it is essential for nurses to provide clear, accurate, and relevant information to patients regarding postoperative care, including the management of drainage tubes. Understanding the rationale behind postoperative instructions empowers patients to participate actively in their recovery process and promotes a smooth transition from the hospital to home care.

Correct Answer: C

Rationale: In the context of Maria developing peptic ulcer disease due to NSAID use, the correct answer is C) Misoprostol (Cytotec). Misoprostol is a prostaglandin analog that helps prevent NSAID-induced ulcers by promoting mucus production in the stomach, enhancing mucosal defense, and reducing acid secretion. This drug is particularly effective in patients like Maria who require NSAIDs for pain management but are at risk for developing ulcers. Option A) Calcium carbonate (Tums) is an antacid that provides symptomatic relief but does not prevent NSAID-induced ulcers. Option B) Famotidine (Pepcid) is an H2 receptor antagonist that reduces acid production but does not address the underlying issue of mucosal protection. Option D) Sucralfate (Carafate) is a cytoprotective agent that forms a protective barrier over ulcers but does not specifically prevent NSAID-induced ulcers like Misoprostol does. In an educational context, understanding the mechanism of action of drugs used to prevent and treat gastrointestinal issues related to NSAID use is crucial for nursing practice. Nurses need to know the rationale behind selecting Misoprostol in this scenario to provide optimal care for patients like Maria and prevent complications associated with NSAID therapy.